MANAGING NAUSEA CAUSED BY L-DOPA

THE ACTIVE INGREDIENT IN MMF

THESE MANAGEMENT PROTOCOLS came from clinical experience and statistical analysis of over two million patient days of de-identified data from over 1,100 medical practices.

DECARBOXYLASE INHIBITORS are known to be effective in the management of L-dopa-induced nausea.³¹ While decarboxylase inhibitors that bind irreversibly to vitamin B6 (B6) and B6-dependent enzymes are of no value in treating disease, they have a powerful ability to bind then deplete B6.³² The serotonin precursor 5-HTP, as found in R&R, through competitive inhibition at the aromatic amino acid decarboxylase (AADC) enzyme, is an effective reversible decarboxylase inhibitor of L-dopa metabolism at the AADC, can manage nausea, and does not deplete vitamin B6.³³

NAUSEA FROM L-DOPA, an active ingredient of mucuna pruriens, usually occurs when the daily dosing value is between 12.0 and 24.0 grams. Experience reveals about 50% of patients experience no nausea when starting the groups on the proper dose of R&R, one tablet per day. One episode of nausea is not significant, but two or more in one day is. Ignoring the warning sign of nausea (no matter how mild it appears), then increasing the daily dose of MMF may induce protracted vomiting. If protracted vomiting does occur, it typically takes the experienced caregiver six to eight weeks to get things back on track and under control. The caregiver will need to be actively involved as soon as possible. The first step in nausea management is to decrease the MMF by 2.4 grams per day and increase the R&R by one tablet per day. Have the patient journal (write down all pills taken with times). Increase the R&R by one tablet for three days. If there is some relief, continue that dose. If no observed relief, increase the R&R daily dosing by one additional tablet per day. Continue adding one tablet every three days until the evaluation of all six R&R dosing levels occurs (1-2-3-4-5-6). With no observed relief on all six daily dosing values, repeat the entire six pill dosing schedule a second time.

NAUSEA MANAGEMENT, Clinical experience reveals two primary etiologies for nausea which may accompany the active ingredient in Mucuna Pruriens, L-dopa. First is an imbalance between serotonin (a hyposerotonergic condition) and dopamine. The second is pre-existing GI pathology which was asymptomatic until dopamine concentrations increased.

Mucuna Pruriens active ingredient L-dopa associated nausea
1-2-3-4-5-6 (twice with journaling)
Gastroenterology referral
Gastroenterology second opinion

Serotonin-dopamine Imbalance drive L-dopa associated nausea.

IF THERE IS NO NAUSEA RELIEF WHEN REPEATED, refer the patient for gastroscopic examination. Over 90% of these patients have GI pathology that did not become symptomatic until the hypodopaminergic condition protocol increased systemic dopamine concentrations. No pathology dominates; it is all over the board. One patient who did not want to have a gastroscopic exam was diagnosed with stomach cancer. Healing of pathology must occur before further MMF optimization can occur.

IF THE GASTROSCOPIC EXAM IS NORMAL, get a second opinion. Unfortunately, many second opinions diagnose pathology not found on the first exam. Healing of pathology is required before further MMF optimization can occur.

WHEN NAUSEA FROM L-DOPA, the active ingredient in Mucuna Pruriens, occurs, decrease the MMF daily dosing to the lowest dose possible, a point where some mild nausea is still present. Some nausea needs to be present to determine the response of nausea to R&R daily dosing adjustments. Therefore, Mucuna dosing not lowered enough when nausea is present will cause the R&R daily dosing changes not to be effective.